2024-08-15T14:32:48+00:00 2023-09-30 346565596 ERNST & YOUNG US LLP 155 N WACKER DRIVE CHICAGO IL 60606 990 2023-01-01 391028657 GUNDERSEN CLINIC LTD GUND 6087827300 1836 SOUTH AVENUE LA CROSSE WI 54601 SCOTT RATHGABER MD CEO 6087827300 2024-08-15 true true Emily Upstrom P01765498 3128792000 2024-08-09 2023 2024-08-08 14:25:15Z SCOTT RATHGABER MD 1836 SOUTH AVENUE LA CROSSE WI 54601 160431292 false X WWW.GUNDERSENHEALTH.ORG X 1963 WI SEE SCHEDULE O. 9 0 0 0 4085398 0 4099508 779738 197499808 159048996 214194 175356 366182 288880 202179692 160292970 2491377 3747508 0 0 0 0 0 0 0 269206748 224045849 271698125 227793357 -69518433 -67500387 198877511 218304419 871161059 958116645 -672283548 -739812226 TO PROVIDE MEDICAL AND SURGICAL SERVICES, ENGAGE IN MEDICAL EDUCATION AND RESEARCH, AND PROMOTE COMMUNITY HEALTH TO DELIVER THE HIGHEST QUALITY COMPREHENSIVE HEALTH CARE TO ALL PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. false false 204607536 3747508 159048996 SEE SCHEDULE O. 204607536 true true false true false false false false false true false false false true true false true false false false false false false false false false true true false false false false false false false false false false false false false false true false false false true 0 0 0 true true false false false false false false false false false false false X 9 0 false true true false true true true true true false false true true true true true true true true false WI X JOHN CEELEN 6087827300 1900 SOUTH AVENUE NCA1-01 LA CROSSE WI 54601 X AZENE EZANA MD MEDICAL GOVERNORS - SECRETARY & TREASURER 2.0 42.0 X X 0 0 0 JENNIFER KLEVEN MD MEDICAL GOVERNORS - CHAIR 2.0 46.0 X X 0 0 0 BENJAMIN JARMAN MD MEDICAL GOVERNORS - MEMBER 2.0 40.0 X 0 0 0 BENJAMIN OROZCO MD MEDICAL GOVERNORS - MEMBER 2.0 40.0 X 0 0 0 CHRISTOPHER EBERLEIN MD MEDICAL GOVERNORS - MEMBER 2.0 43.5 X 0 0 0 ELIZABETH COGBILL MD MEDICAL GOVERNORS - MEMBER (BEGIN 1/23) 2.0 40.0 X 0 0 0 ROBYN BORGE MD MEDICAL GOVERNORS - MEMBER 2.0 42.0 X 0 0 0 STEPHANIE CARROLL MD MEDICAL GOVERNORS - MEMBER (BEGIN 1/23) 2.0 42.5 X 0 0 0 TREY FOLKERS MD MEDICAL GOVERNORS - MEMBER (BEGIN 1/23) 2.0 42.0 X 0 0 0 GERALD OETZEL CHIEF FINANCIAL OFFICER AND TREASURER THRU 8/23 0.0 42.0 X 0 0 0 SCOTT RATHGABER MD CEO, CHAIRMAN 0.0 46.0 X 0 0 0 STEVE LITTLE INTERIM CHIEF FINANCIAL OFFICER AND TREASURER BEGIN 8/23 0.0 42.0 X 0 0 0 0 0 0 0 false false false GUNDERSEN LUTHERAN ADMIN SERVICES INC 1910 SOUTH AVENUE LA CROSSE WI 54601 SERVICES / SUPPLIES 0 138349 578400 62989 779738 MEDICAL SERVICE PROVIDED 621498 155113088 154963598 149490 ONLINE SALES - DERM AND PLASTICS 446199 217714 217714 VISION 446130 159591 159591 PHARMACY 446110 1765898 1765898 DIAGNOSTIC TESTING INCOME 621511 1792705 1792705 0 0 0 0 159048996 218469 218469 374089 85209 288880 0 288880 288880 10000 53113 0 -43113 -43113 -43113 0 0 0 0 0 160292970 154963598 4085398 464236 1004078 1004078 2743430 2743430 0 0 50206412 45106956 5099456 3550 3550 31069 31069 4950 4950 8779993 8355610 424383 0 17377 7955 9422 1623716 1496231 127485 407716 304591 103125 4307846 2778312 1529534 614225 600720 13505 55789 55591 198 -55 -55 8533297 4651391 3881906 484933 67999 416934 LEASED EMPLOYEES 116100403 104581258 11519145 SUPPLIES/BAD DEBTS 31943883 31915035 28848 DUES, MEMBERSHIPS, LICENSES 774074 762319 11755 TAXES 95869 95490 379 60802 45951 14851 0 227793357 204607536 23185821 0 80721 101757 11686765 12675090 0 0 0 0 6829708 9675280 410888104 232919942 161659385 177968162 10527064 10234045 0 0 2010476 2031994 6083392 5618091 198877511 218304419 4538752 3675704 13345 0 0 0 866608962 954440941 871161059 958116645 X -672283548 -739812226 -672283548 -739812226 198877511 218304419 -67500387 -28291 0 X false true X true true true X Schedule A, Part I SUPPLEMENTAL INFORMATION THE CLINIC HAS OBTAINED TAX-EXEMPT STATUS AS AN ORGANIZATION WHOSE MAIN PURPOSE IS TO PROVIDE MEDICAL CARE. HOWEVER, THE CLINIC IS NOT REQUIRED TO BE LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED BY THE STATE OF WISCONSIN AS A HOSPITAL AND IS NOT REQUIRED TO FILE SCHEDULE H. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 31069 276873 31069 276873 227762288 2156545660 227793357 2156822533 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 259182 380642 242027 276873 1158724 250000 250000 250000 250000 1000000 1500000 0 0 0 0 8251788 8251788 284604881 140887622 143717259 116130431 90671548 25458883 1901004 1360772 540232 177968162 INTERCOMPANY PAYABLE 941734338 MALPRACTICE CLAIM RESERVE 7241517 ASSET RETIREMENT OBLIGATIONS 1274423 OPERATING LEASE OBLIGATIONS 4190663 954440941 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote INCOME TAX MATTERS (DOLLARS IN THOUSANDS) THE SYSTEM QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE), WITH THE EXCEPTION OF GUNDERSEN LUTHERAN ENVISION, LLC AND GUNDERSEN EDGE, LLC, WHICH ARE FOR-PROFIT ENTITIES. AT SEPTEMBER 30, 2023 AND NOVEMBER 30, 2022, NET DEFERRED TAX ASSETS OF $7,057 AND $7,351, RESPECTIVELY, WHICH PRIMARILY ARE RELATED TO NET OPERATING LOSS CARRYFORWARDS, HAVE VALUATION ALLOWANCES OF $7,057 AND $7,351, RESPECTIVELY, RECORDED AGAINST THEM DUE TO THE UNCERTAINTY OF REALIZING THOSE BENEFITS IN THE FUTURE. AT SEPTEMBER 30, 2023, THE SYSTEM'S FEDERAL NET OPERATING LOSS CARRYFORWARDS WERE APPROXIMATELY $26,700, AND THE STATE NET OPERATING LOSS CARRYFORWARDS WERE APPROXIMATELY $24,600, WHICH WILL EXPIRE BETWEEN 2032 AND 2041. THE SYSTEM HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS. THE SYSTEM'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR 2018 AND PRIOR YEARS. true Gundersen Lutheran Medical Foundation Inc 1836 South Avenue La Crosse WI 54601 391249705 501(C)(3) 979407 Operations Support 1 0 CHARITY CARE 4083 2743430 BOOK CHARITY CARE Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS ASSISTANCE WAS TO A RELATED ORGANIZATION, FUNDS ARE MONITORED BY MANAGEMENT AND THE BOARD OF GOVERNORS. Form 990, Part I, Line 1 ORGANIZATION'S MISSION TO PROVIDE MEDICAL AND SURGICAL SERVICES, ENGAGE IN MEDICAL EDUCATION AND RESEARCH, AND PROMOTE COMMUNITY HEALTH TO DELIVER THE HIGHEST QUALITY COMPREHENSIVE HEALTH CARE TO ALL PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS GUNDERSEN CLINIC, LTD. (THE CLINIC) HAS 679 PHYSICIANS REPRESENTING NEARLY EVERY SPECIALTY SERVING A 21 COUNTY REGION IN WESTERN WISCONSIN, NORTHEASTERN IOWA AND SOUTHEASTERN MINNESOTA. THE CLINIC PROVIDES MEDICAL CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. CHARITY CARE AND/OR FINANCIAL ASSISTANCE IS DETERMINED BASED ON FINANCIAL INFORMATION PROVIDED BY THE PATIENT AND ANALYSIS OF OTHER RELEVANT INFORMATION. THERE WERE APPROXIMATELY 823,436 PATIENT ENCOUNTERS FOR 2023 (JAN-SEP). THE CLINIC PROVIDED UNCOMPENSATED CARE RELATED TO CHARITY AT COST, $1,793,991; MEDICARE, $29,169,515; AND MEDICAID, $15,812,332 FOR THE TOTAL AMOUNT OF $46,775,838 AT COST BASED ON POLICIES AND CONTRACTS ARRANGED TO HELP SUPPORT THE COMMUNITY'S NEEDS. THE $46,775,838 IS THE SUM OF UNREIMBURSED MEDICARE & MEDICAID COST PLUS CHARITY AT COST. ALL OF THESE ARE CALCULATED USING THE SAME METHOD UTILIZED FOR THE HOSPITAL CALCULATION OF CHARITY COST AND UNREIMBURSED MEDICARE AND MEDICAID COSTS. THE COST OF CHARITY IS CALCULATED BY ALLOCATING THE COST TO PROVIDE SERVICES TO A PATIENT BETWEEN ANY PAYMENTS, BAD DEBT, AND CHARITY WRITE-OFFS WHERE TOTAL PAYMENTS ARE LESS THAN THE COST OF SERVICES PROVIDED. THE UNREIMBURSED MEDICARE AND MEDICAID COSTS ARE CALCULATED BY COMPARING THE COST OF SERVICES TO MEDICARE AND MEDICAID PATIENTS TO THE NET REVENUE FOR THOSE SAME PATIENTS. THE UNREIMBURSED COST IS THE AMOUNT THE COST EXCEEDS THE NET REVENUE FOR THOSE SAME PATIENTS. MEDICARE AND MEDICAID PATIENTS TO THE NET REVENUE FOR THOSE SAME PATIENTS. THE UNREIMBURSED COST IS THE AMOUNT THE COST EXCEEDS THE NET REVENUE FOR THOSE SAME PATIENTS. Form 990, Part VI, Line 15 A AND B - PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL ALL PERSONNEL SERVICES FOR GUNDERSEN CLINIC, LTD. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. THE COMPENSATION OF THE CEO IS DETERMINED ANNUALLY BY A COMMITTEE MADE UP OF THE COMMUNITY MEMBERS OF THE BOARD OF TRUSTEES. THEIR DETERMINATION IS MADE AFTER A REVIEW OF MARKET DATA OBTAINED FROM SEVERAL ORGANIZATIONS AND CEO PERFORMANCE. MEETING MINUTES ARE TAKEN AND KEPT AT THE MEETINGS WHERE SUCH DISCUSSIONS TAKE PLACE. RECOMMENDATIONS FOR COMPENSATION FOR THE ORGANIZATIONS' KEY MANAGEMENT EMPLOYEES ARE DEVELOPED ANNUALLY BY THE CEO, AFTER A REVIEW OF PERFORMANCE AND COMPARABLE MARKET DATA. THE PROPOSED SALARIES ARE INDEPENDENTLY REVIEWED BY AN OUTSIDE AUDITING FIRM. THE COMPENSATION RECOMMENDATIONS, AUDIT REPORTS, ALONG WITH THE MARKET DATA, ARE PRESENTED TO A COMMITTEE MADE UP OF THE COMMUNITY MEMBERS OF THE BOARD OF TRUSTEES. THE COMPENSATION AMOUNTS ARE NOT EFFECTIVE UNTIL THE BOARD COMMITTEE APPROVES THEM. MEETING MINUTES ARE TAKEN AND KEPT AT THE MEETINGS WHERE THE BOARD REVIEWS AND APPROVES THE COMPENSATION OF THE KEY EMPLOYEES. Form 990, Part VI, Line 3 Delegation of management duties ALL MANAGEMENT AND PERSONNEL SERVICES FOR GUNDERSEN CLINIC, LTD. ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICE, INC. Form 990, Part VI, Line 4 Significant changes to organizational documents IN JULY AND SEPTEMBER 2023, THE BYLAWS AND ARTICLES OF INCORPORATION, RESPECTIVELY OF GUNDERSEN CLINIC, LTD. ("CORPORATION") WERE AMENDED TO SPECIFY THE POWERS RETAINED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. THE CHIEF EXECUTIVE OFFICER OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. RETAINS AUTHORITY TO APPROVE ANY SIGNIFICANT CHANGES TO THE CORPORATION. SUBJECT TO THE RESERVED POWERS SPECIFIED IN THE BYLAWS, THE AFFAIRS OF THE CORPORATION SHALL BE MANAGED BY ITS MEDICAL GOVERNORS. Form 990, Part VI, Line 6 Classes of members or stockholders GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF THIS ORGANIZATION. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE CORPORATE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., HAS THE POWER TO APPOINT BOARD MEMBERS. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE CORPORATION'S SOLE SHAREHOLDER IS GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. THE BYLAWS MAY BE AMENDED BY THE BOARD WITH APPROVAL OF THE PARENT CORPORATION, OR BY THE VOTE OF THE SOLE SHAREHOLDER. ALSO, THE AFFAIRS OF THE CORPORATION SHALL BE MANAGED UNDER THE DIRECTION OF THE CORPORATION'S BOARD OF GOVERNORS, SUBJECT TO CERTAIN APPROVAL POWERS OF THE BOARD OF GOVERNORS AND BOARD OF TRUSTEES OF THE PARENT CORPORATION. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORM 990 WILL BE AVAILABLE FOR ALL BOARD MEMBERS BEFORE FILING AND UPON FURTHER REVIEW BY THE CFO, VICE-PRESIDENT OF FINANCE OR DIRECTOR OF FINANCE, THE 990S ARE APPROVED AND FILED. Form 990, Part VI, Line 12c Conflict of interest policy GUNDERSEN CLINIC, LTD. MONITORS CONFLICTS ON AN ANNUAL BASIS BY REVIEWING DISCLOSURES ON COMPLETED CONFLICT OF INTEREST STATEMENTS. Form 990, Part VI, Line 19 Required documents available to the public REQUESTS FOR ALL DOCUMENTS ARE MADE THROUGH THE LEGAL DEPARTMENT AND THE APPROPRIATE DOCUMENTS ARE MADE AVAILABLE FOR INSPECTION IN THE LEGAL DEPARTMENT. Form 990, Part VII, Section A, Line 1a COMPENSATION REPORTING DUE TO THE SHORT YEAR RETURN IN WHICH THERE WAS NO CALENDAR YEAR THAT ENDS WITH OR WITHIN THE SHORT YEAR, NO REPORTABLE COMPENSATION IS SHOWN FOR INDIVIDUALS LISTED ON PART VII OF THE 990 RETURN. AS SUCH, NO KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES, OR INDEPENDENT CONTRACTORS ARE LISTED PER THE REPORTING INSTRUCTIONS. Form 990, Part VIII, Line 2a PROGRAM SERVICE REVENUE THE PROVISION OF MEDICAL SERVICES IN A MANNER BENEFICIAL TO THE COMMUNITY FURTHERS GUNDERSEN CLINIC, LTD.'S CHARITABLE PURPOSE OF PROMOTION OF HEALTH. 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